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Managing Co-Morbidities for the Older Adult

Jan 09, 2012

Written by A. Lynn Millar, P.T., Ph.D., FACSM

A concern often voiced by older adults in regards to starting or maintaining an exercise program is their safety. As we age, the chances of having at least one health problem, if not multiple issues, greatly increases. While the number varies, by age 65, the majority of Americans has at least one chronic health problem, and almost half have more than one. The term for more than one chronic disease is “co-morbidity.” Some of the most common comorbidities include cardiovascular disease and its risk factors (which include hypertension, obesity and hyperlipidemia), diabetes, peripheral vascular disease and arthritis. Unfortunately, individuals often fail to educate themselves and act on their health concerns, and many become increasingly sedentary. However, regular physical activity can help decrease many of the negative consequences brought about by age-related chronic health conditions.

Exercise reduces multiple disease risk factors and helps maintain function. Among other benefits, regular activity controls body weight, resting heart rate, blood pressure and blood sugar. Importantly, even low-level activity will produce some of these benefits. In other words, you do not need to participate in intense exercise to see healthy improvements. While there are numerous fitness-related articles and books devoted to different chronic diseases, few specifically address what you should do when you have multiple comorbidities. Managing co-morbidities, including developing an activity plan to help improve your health and function, can be accomplished many ways. One stepwise approach involves getting informed, consulting with your physician, getting organized, enlisting support, getting started and monitoring your response. Becoming more active may seem overwhelming; however, completing one step at a time can make the process doable.

  1. Get informed. If you have more than one chronic disease, an educated, common-sense approach will allow you to safely and effectively participate in activity. Learn as much as you can about each of your diseases from a reliable source. This may be a national organization devoted to assisting individuals with that disease, such as the American Heart Association. Such organizations often have informational brochures and other educational materials. ACSM has a series of texts devoted to physical activity and specific chronic diseases, such as arthritis, hypertension and diabetes.
  2. Consult. If you have not been very active previously, consult with your physician before starting exercise. The doctor can let you know if there are any contraindications or precautions related to each specific health problem. If you have not seen a doctor for a while, some tests may be necessary. Make sure that you discuss each co-morbidity with your physician. Otherwise, your doctor may be focused on what he or she considers the primary disease and overlook a possible interaction with another health concern.
  3. Get organized. Make yourself a list of each health problem you have, the medications you take for that problem and the precautions that the physician has identified for each problem. For example, if you have hypertension, you first need to make sure that it is under control. Some medications will alter your heart rate and blood pressure response to exercise; thus, intensity of exercise will be determined by your perception, not by your heart rate. Further, find out what techniques are important to safely participate in an activity. For example, during resistance training, you need to avoid the Valsalva maneuver (breath holding while exerting force), as this can cause abnormal changes in blood pressure. Then add in the precautions or concerns for the next disease. Let’s say you also have diabetes and are on insulin. The timing of your activity will be important, as you may need to set the daily activity based upon when you eat and when you take your insulin.
  4. Enlist support. Having support from family, friends or outside groups is invaluable. Find out if there are activities aimed at individuals with your specific conditions. Not only will the others in the group understand and be supportive of your specific needs, but because the instructors are educated about that disease, they can help you modify the activity. Certified instructors often learn about numerous disease processes and the modifications that need to be made, so they can help you adjust exercise based on your co-morbidities, even if the activity is advertised to one type of condition.
  5. Get started. Now that you have covered the basics, you are ready to get started. If your support is through an exercise group, then this step is easier, as the starting point and activity is already identified. If you are going to start with a home-based program, keep it simple. Start with one activity, and do not overdo it. This is why walking is often used—it does not need much in the way of equipment (good shoes), it is functional and you can set the intensity or duration at a very low level to start.
  6. Monitor your response. As you commence increasing your new activity program, keep a diary. Record the activity and your response, noting any unusual symptoms. While we all will have occasional pains or symptoms that do not seem normal, recurring or progressing symptoms may be significant. A diary is a simple way to identify patterns and improving symptoms. With some diseases this is extremely important, as your physician may need to adjust your medications as your body adapts to the positive changes that come with regular activity.

Importantly, do not let the presence of more than one chronic disease deter you from incorporating regular activity into your life. Take it one step at a time, and remember that change takes time.

View the full fall 2011 issue of the ACSM Fit Society® Page supported by Liberty Mutual online.

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